Regional political pressure should not be allowed to limit the sustainable development of acute surgical services in regions like Otago and Southland, the chairman of the New Zealand board of the Royal Australasian College of Surgeons said.
The campaign to retain neurosurgery services in Dunedin reflected what was going on elsewhere as provincial district health boards and smaller hospitals tackled their "vulnerabilities", John Kyngdon said during a meeting of college surgeons in Queenstown yesterday.
"There's a huge amount of emotion there, and I think that we really hope that the review can come up with a really good decision," Mr Kyngdon, of Gisborne, said.
"I would like to see it resolved in a really good way, and in a way that meets the requirements of a very well-established and internationally famous medical school.
"It would have to suit the requirements of all the parties involved but it must be a really good solution."
The college would not comment on the debate, and did not want to do anything that could prejudice the review, Mr Kyngdon - who this month told Radio New Zealand it would be better for patients if the South Island's six neurosurgeons were based in one place - said.
It was not expressly discussing the neurosurgery issue during the Queenstown meeting but, in general, it believed health managers should look at new ways to ensure equitable access to acute medical care was maintained.
College members discussed a draft paper that warned acute surgical services everywhere in New Zealand must not be constrained by modes of service provision, or local political pressures.
The draft was not publicly available, but Mr Kyngdon said politics followed funding models that penalised health boards for not meeting elective surgery targets and which encouraged boards not to "share" patients or services.
The surgeons at the Queenstown meeting wanted to move past those pressures to explore new ways to make "marginal", acute services at small hospitals more secure.
The college believed a centre needed to have at least 60,000 to 80,000 people to have a viable, 24-hour acute surgical service.
A ratio of one general and one orthopaedic surgeon for every 15,000 to 20,000 people was appropriate.
In one of several models likely to be discussed, big and small hospitals would make dual appointments so that staff were shared according to demand.
In another, after-hours care could be provided in the large centre or specialist support could be provided using new communication technologies.
Other models recognised it might not be possible to adequately staff some smaller hospitals for a 24-hour acute surgical service, but that operating theatres and staff could still provide semi-acute surgical care and elective surgery as part of a regional service.
"What we are saying is that we need to look at everything we can to make sure that services are kept viable, and that all the resources are used to capacity," Mr Kyngdon said.
"There are no hospitals that we think should close. If we do things right, if we build-up those smaller hospitals, we should achieve quite the opposite."
Southern District Health Board chief executive Brian Rousseau said there was little doubt district health boards should collaborate to ensure communities got the services they deserved.
"Centralising services is not the answer. It is a solution for the bureaucrats to come to, but it is not one that supports patients or good, safe and sustainable access to services."
Staff and services were shared between Dunedin and Invercargill Hospitals and there was no reason why they should not be between DHBs.
If moving people between the likes of Oamaru and Timaru would ensure the viability of services in both centres, then it should be considered, Mr Rousseau said.
"That is what we have been saying for some time: DHBs must work together to get clinical networks established that can only enhance the services that are available to communities."
